Table 6.

Alternative measures: summary on the evidence on the efficacy, associated risks and specific knowledge gaps

Alternative	Target species	Reported data on potential efficacy	Risksa	Current regulatory framework applicable	Effects on nutrition and performances	Knowledge gaps	Comments
Probiotics	Calves	Reduction of diarrhoeal infections	Presence of virulence factors and/or AMR determinants in strains used as probiotics	Some of the strains are authorised as zootechnical feed additives	Demonstration of performance improvements for strains authorised as zootechnical feed additives under Regulation (EC) No 1831/2003	Mode of action of probiotics Dose response Limited controlled trials to support efficacy	Data on efficacy as alternatives to antimicrobials are strictly strain dependent
	Pigs	Reduction of diarrhoeal infections in weaned piglets
	Chickens	Reduction of C. perfringens‐induced necrotic enteritis
	Fish, crustacea and mollusca	Reduction of mortality due to bacterial infections, mainly at larval stage
Competitive exclusion products	Chickens	Reduction of C. perfringens‐induced necrotic enteritis	Possible spread of viruses and pathogens Possible spread of AMR	Not authorised under a specific EU regulatory framework		Dose response limited controlled trials to support efficacy
Predatory bacteria	Chickens	Reduced colonisation with Salmonella spp.		Not authorised under a specific EU regulatory framework		Very limited data to support efficacy	Data on efficacy as alternatives to antimicrobials are strictly dependent to the strain of predatory bacterium used and to its host range
Bacteriophages	Chickens	Reduction of colibacillosis	Emergence of phage resistant populations. Might carry AMR determinants Transduction of virulence genes in the target bacterial population	Not authorised under a specific EU regulatory framework		Long‐term efficacy Dose response Limited number of studies to support the efficacy	Data on efficacy as alternatives to antimicrobials are strictly dependent to the strain of phage used and to its host range
	Aquaculture	Reduction of bacterial infections
Antibodies	All species	Reduction of diarrhoea in neonatal and post‐weaning pigs	Viruses and/or pathogen contamination of the products	Few old veterinary biological products or Not authorised under a specific EU regulatory framework		Dose response studies Limited controlled trials to support efficacy
Immunomodulators	Chickens	Reduction of colibacillosis in chickens	Toxicity residue	Veterinary medicinal products or Not authorised under a specific EU regulatory framework		Limited number of studies to support the efficacy
	Fish	Reduction of bacterial infections
	Cattle	Reduction of mastitis
Antimicrobial Peptides	Chickens	Antibacterial activity	Toxicity	VPMs Not authorised under a specific EU regulatory framework		Lack of controlled trials to support efficacy Pharmacolgy
Organic acids	Chickens	Reduction of necrotic enteritis in chickens and of diarrhoea in pigs		Some of the molecules are authorised as technological feed additivesb		Lack of controlled trials to support efficacy
	Pigs
Clays	Pigs	Binder of toxins	Risk of contaminants	Authorised as feed additives	Binders, anticaking agents	Limited controlled trials to support efficacy
Prebiotics	All animals	Microbiota development Antitoxins	Antinutritive or toxic residue	Some authorised as feed additives	Can be used as fibre sources, astringent substances, mucilaginous substances	Mode of action Pharmacology Chemical composition Limited controlled trials to support efficacy	Data on efficacy as alternatives to antimicrobials are strictly product/formulation dependent
Symbiotics	Chickens Pigs Fish	Reduction of bacterial infections	As for probiotics and prebiotics	As for probiotics and prebiotics	As for probiotics and prebiotics	As for probiotics and prebiotics	As for probiotics and prebiotics
Zinc oxide	Piglets	Prevention of post‐weaning diarrhoea in piglets	Cross selection for AMR bacteria Environmental risk	Authorised as veterinary medicinal products and as a feed additive	Nutritional additive	Limited controlled trials to support efficacy
Botanicals	All animals	Antibacterial activity Immunomodulation Microbiota development	Toxicity residue	Some are authorised as feed additives Lack of veterinary phytobiotics assessment guidelines as veterinary products	Natural products Botanically defined	Mode of action Pharmacology Chemical composition Limited controlled trials to support efficacy	Data on efficacy as alternatives to antimicrobials are strictly product/formulation dependent
Teat sealants	Dairy cows	Reduction of intrammary infections		VMPs

AMR: antimicrobial resistance; VMP: veterinary medicinal product.

^aAn assessment of the risk related to the use of this potential alternative for the animals, the consumers of food of animal origin and the environment shall be performed, following the requirements of specific authorisation frameworks (e.g. VMP or Feed Additives).

^bFeed additives shall favourably affect animal production, performance or welfare, particularly by affecting the gastrointestinal flora, as per Regulation (EC) No 1831/2003.